Juan Mata, Julio F Fiore, Nicolo Pecorelli, Patrick Charlebois, Sender Liberman, Barry Stein, Liane S Feldman. McGill University
Introduction: Evidence suggests that increased adherence to enhanced recovery program (ERP) elements is associated with better postoperative outcomes after colorectal surgery and that adherence is lowest to postoperative elements. Identification of risk factors for lower adherence may help target interventions focused on patient engagement and care organization. The aim of this study was to estimate the extent to which patient, procedural and organizational factors predict adherence to ERP elements after laparoscopic colorectal surgery.
Methods: Patients in an institutional ERP registry undergoing elective laparoscopic colorectal surgery between 2012 and 2014 were analyzed. The ERP included 11 postoperative ERP elements classified in 2 groups: those requiring patient participation (PP, 6 elements) and those dependent on the clinical team to provide (CT, 5 elements). Impact of baseline and intraoperative factors on adherence was estimated using stepwise linear regression.
Results: There were 250 patients included (mean age 65, 51% male). Mean (SD) adherence for the PP bundle was 72(25)% (range 62% to 76% for individual elements), and for the CT bundle was 81(19)% (range 71% to 87% for individual elements). Complications occurring in the first 24hours predicted lower adherence to both bundles. In the PP bundle, patients who arrived on the ward after 6 PM (mainly affecting protein supplement intake and early mobilization) and females had lower adherence. In the CT bundle, lower adherence was predicted by rectal resection and lengthy surgeries. Epidural use predicted higher adherence. (Table 1)
a PP Bundle: POD 0 oral fluid intake, POD 0and 1 nutritional drink intake, POD 1 solid food intake, mobilization within 24hours, chewing gum.
b CT Bundle: POD 1 IV Fluid termination, POD 1 adequate laxative use, use of multimodal analgesia, POD2 transition to oral analgesia, POD 1 urinary catheter removal.
c Coefficients should be interpreted as the % change in adherence per group or per unit of measure.
d Segments of 30 minutes.
Conclusions: With the exception of early complications, predictors of adherence to a colorectal ERP differed for elements requiring patient participation compared to other care processes and require different strategies to improve adherence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80520
Program Number: S040
Presentation Session: Colorectal 1
Presentation Type: Podium